Download What is Cancer?

Ovarian tumor
-----From textbook to application
Wei Jiang, M.D., Ph.D.
Attending of Ob & Gyn
Ob & Gyn Hospital, Fudan University
419 Fangxie Road, Shanghai
[email protected]
Overview
Key points
Case discussion
What is the difference between
cancer and tumor?
What do you think?
What is Cancer?
• Simplest definition
From the American Cancer Society
“ cancer is a group of diseases characterized by
uncontrolled growth and spread of abnormal cells. If
the spread is not controlled, it can result in death.”
• Tumor
– Two types:
• Benign (non-cancerous) – not cancer!
– Does not spread; it can eventually become malignant in
some cases.
• Malignant (cancerous) – this is cancer!
– Has the potential to spread to other parts of body
Role of Cell Division in Cancer
Top = normal cell division
Bottom = unregulated cell
division and tumor formation
Malignant
If tumor invades
surrounding tissue
(cancerous)
Benign
If tumor has no effect on
surrounding tissue
(non-cancerous)
Metastatic
If individual cells break
away and start a new
tumor elsewhere
(cancerous)
Image from the National Cancer Institute
5
Primary ovarian tumors
• Epithelial: serous; mucinous; endometroid
- Benign
- Borderline
- Malignant
• Germ cell tumors
• Sex cord (gonadal stromal) tumors
Epithelial
EOC
Germ cell tumors
Sex cord tumors
Complications
 Torsion 10%
 Rupture 1%
 Infection
 Malignancy
Case discussion
Case 1
A 23-year-old female presented to our hospital in April 2013 with
months history of increasing facial and truncal hair, acne. The
patient had been amenorrheic for 2 years prior to the onset of her
virilizing symptoms. In the recent one year, she was treated as
Polycystic Ovary Syndrome (PCOS) in the local hospital, but the
signs and symptoms were deteriorated
Physical examination revealed a 56kg, normotensive female with
obvious facial hair and atrophy of the breasts. Excessive hair was
present on her lower abdomen and thighs. Pelvic examination was
notable for an enlarged clitoris and a 5cm right adnexal mass.
Abdominal ultrasound identified a 64×52×51mm, solid, left ovarian
tumor. Doppler evaluation of intratumoral blood vessels confirmed a
low resistance to flow. No ascites or other abnormalities were
present. A CT scan of the pelvis confirmed the ultrasound findings
and detected no adrenal gland enlargement or tumor. Laboratory
analysis revealed normal values of folicle stimulating hormone
(FSH), luteinising hormone (LH), serum prolactin (PRL) and cortisol.
Total serum testosterone was 3.68ng/ml (normal 0.15-0.51ng/ml),
Clinical thinking
What is the most likely diagnosis?
What should be your next steps?
How would you confirm the diagnosis?
Laparoscopic examination
• Identified a 6×5×5cm, enlarged right
ovary.
• Oophorocystectomy
After operation………
• Pathological diagnosis: ovarian steroid cell
tumor
• T: 1.02
A
B
Case 2
•
•
A 39-year-old, female, gravida 1, para 1, was admitted to a local hospital,
complaining of fatigue, anorexia, and abdominal swelling. Her medical
history included nothing special. Physical examination revealed a palpable
mass in the lower abdomen. A thoracoabdominal computed tomography
(CT) scan showed marked pleural effusion and a heterogeneous mass,
large ascites with many nodosity images in the pelvic wall.
She was transferred to our hospital for further treatment. The patient’s
serum CA 125 level was 1230.9U/mL, while CEA, AFP, CA 199, and CA 153
levels were within the normal range. Abdominal ultrasonography showed a
heterogeneous, multiloculated mass, with a moderate amount of ascites,
and subsequent transvaginal ultrasonography revealed a large complex
pelvic mass, 16cm largest dimension, of probable adnexal origin. The
uterus was normal in size. Abdominal paracentesis yielded 2 liters of yellow
serous fluid consistent with an exudative process. Microscopy and cytology
revealed only reactive mesothelial cells without malignant cells.
Clinical thinking
– What is the most likely diagnosis?
– What should be your next steps?
– How would you confirm the diagnosis?
Chemotherapy?
Laparoscopy？
Exploratory laparotomy？
Exploratory laparotomy
• Two rounds of TP
– Ascites fall down
– CA125: 820
• Operation
– Ascites: clear, yellow
– The uterus and left ovary was normal
– Right ovary: A 20×18×15cm complex, multicystic mass, without
evidence of external excrescences
After operation…….
• CA125: 235
• Pathological diagnosis: Struma ovarii
Case 3
From ER:
A 32-year-old female presented with a
sudden lower right abdominal pain